Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/201—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser with beam delivery through a hollow tube, e.g. forming an articulated arm ; Hand-pieces therefor
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F9/00825—Methods or devices for eye surgery using laser for photodisruption
  • A61F9/0084—Laser features or special beam parameters therefor
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F9/009—Auxiliary devices making contact with the eyeball and coupling in laser light, e.g. goniolenses
• • G—PHYSICS
  • G02—OPTICS
  • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
  • G02B6/00—Light guides; Structural details of arrangements comprising light guides and other optical elements, e.g. couplings
  • G02B6/02—Optical fibres with cladding with or without a coating
• • G—PHYSICS
  • G02—OPTICS
  • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
  • G02B6/00—Light guides; Structural details of arrangements comprising light guides and other optical elements, e.g. couplings
  • G02B6/02—Optical fibres with cladding with or without a coating
  • G02B6/02295—Microstructured optical fibre
  • G02B6/023—Microstructured optical fibre having different index layers arranged around the core for guiding light by reflection, i.e. 1D crystal, e.g. omniguide
  • G02B6/02304—Core having lower refractive index than cladding, e.g. air filled, hollow core
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B2018/2035—Beam shaping or redirecting; Optical components therefor
  • A61B2018/20351—Scanning mechanisms
  • A61B2018/20359—Scanning mechanisms by movable mirrors, e.g. galvanometric
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B2018/2035—Beam shaping or redirecting; Optical components therefor
  • A61B2018/2045—Choppers
  • A61B2018/205—Choppers with electronic means, e.g. acousto-optic
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B2018/2035—Beam shaping or redirecting; Optical components therefor
  • A61B2018/20554—Arrangements for particular intensity distribution, e.g. tophat
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
  • A61B2018/2205—Characteristics of fibres
  • A61B2018/2222—Fibre material or composition
  • A61B2018/2227—Hollow fibres
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F2009/00844—Feedback systems
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
  • A61F2009/0087—Lens
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
  • A61F2009/00872—Cornea
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
  • A61F9/007—Methods or devices for eye surgery
  • A61F9/008—Methods or devices for eye surgery using laser
  • A61F2009/00897—Scanning mechanisms or algorithms

Definitions

• the present invention relates to the technical field of treatment of ocular pathologies carried out using a femtosecond laser, and more particularly that of ophthalmic surgery for including applications of cornea cutting, or crystalline lenses.
• the invention relates to a device for cutting human or animal tissue, such as a cornea, or a lens, by means of a femtosecond laser.
• femtosecond laser a light source capable of emitting a LASER beam in the form of ultra-short pulses, whose duration is between 1 femtosecond and 100 picoseconds, preferably between 1 and 1000 femtoseconds, in particular from order of a hundred femtoseconds.
• Document FR 3,049,847 describes an apparatus for cutting human or animal tissue, such as a cornea, or a lens. This apparatus comprises:
• a femtosecond laser for generating a LASER beam
• a shaping system positioned on the path of said beam, for modulating the phase of the wavefront of the LASER beam so as to obtain a phase-modulated LASER beam according to a modulation instruction calculated to distribute the energy of the LASER beam; in at least two impact points forming a pattern in its focal plane corresponding to a cutting plane,
• an optical scanning scanner disposed downstream of the shaping system for moving the pattern in the cutting plane at a plurality of positions in a direction of movement;
• an optical assembly including reflecting mirrors and lenses between the shaping system and the optical scanner for transmitting the modulated LASER beam to the scanner, an optical focusing system for focusing the LASER beam in a cutting plane.
• the use of the shaping system makes it possible to obtain substantially equal points of impact (the shape, the position and the diameter of each point being dynamically controlled by a phase mask calculated and displayed on the control system. formatting).
• the gas bubbles - generated by the points of impact and - which expanded the cut biological tissues are of substantially equal size.
• an aim of the present invention is to propose a technical solution making it possible to improve the homogeneity of the energy distribution between the different points of impact generated. simultaneously thanks to the formatting system.
• Another object of the present invention is to provide a technical solution for improving the apparatus described in FR 3,049,847 in order to reduce the size of the residual tissue bridges between adjacent impact points.
• Another object of the present invention is to improve the safety of the apparatus described in FR 3,049,847 by incorporating therein a security device making it possible to interrupt the transmission of the laser beam to the tissue to be treated if said laser beam offsets (eg in case of shock to the device).
• the invention provides an apparatus for cutting a human or animal tissue, such as a cornea, or a lens, said apparatus including a femtosecond laser for emitting an initial LASER beam in the form of pulses,
• a shaping system such as a spatial light modulator (SLM) positioned downstream of the femtosecond laser, for transforming the initial LASER beam into a phase-modulated LASER beam, the shaping system being able to modulate the phase of the wavefront of the initial LASER beam according to a modulation instruction calculated to distribute the energy of the LASER beam in at least two impact points forming a pattern in a focusing plane,
• SLM spatial light modulator
• an optical scanning scanner positioned downstream of the shaping system, for moving the pattern along a predefined movement path in the plane of focus
• an optical focusing system positioned downstream of the scanning optical scanner, for moving the focussing plane of the modulated LASER beam in a cutting plane of the desired tissue
• control unit for controlling the shaping system, the scanning optical scanner and the focusing optical system
• the apparatus further comprises an optical coupler between the femtosecond laser and the shaping system, the optical coupler including a photonic crystal optical fiber for filtering the LASER beam from the femtosecond laser.
• point of impact refers to a zone of the LASER beam comprised in its focal plane in which the intensity of said LASER beam is sufficient to generate a gas bubble in a tissue.
• adjacent points of impact means two impact points arranged facing each other and not separated by another point of impact.
• Nearboring impact points means two points in a group of adjacent points between which the distance is minimal.
• pattern is understood to mean a plurality of LASER impact points generated simultaneously in a focussing plane of a shaped LASER beam - that is, modulated in phase for distribute its energy in several distinct spots in the plane of focus corresponding to the cutting plane of the device.
• the invention makes it possible to modify the intensity profile of the LASER beam in the plane of the cut, so as to be able to improve the quality or the speed of the cut according to the chosen profile. This intensity profile modification is obtained by modulating the phase of the LASER beam
• Optical phase modulation is achieved by means of a phase mask.
• the energy of the incident LASER beam is conserved after modulation, and beam shaping is performed by acting on its wavefront.
• the phase of an electromagnetic wave represents the instantaneous situation of the amplitude of an electromagnetic wave.
• the phase depends on time as well as space. In the case of spatial shaping of a LASER beam, only variations in the phase space are considered.
• the wavefront is defined as the area of the points of a beam having an equivalent phase (i.e. the area consisting of the points whose travel times from the source having emitted the beam are equal).
• the modification of the spatial phase of a beam thus passes through the modification of its wavefront.
• This technique makes it possible to perform the cutting operation in a faster and more efficient manner because it implements several LASER spots each making a cut and according to a controlled profile.
• Positioning the optical coupler including the photonic crystal optical fiber between the femtosecond laser and the shaping system avoids any disruption in the optical coupler.
• the shaping of the laser beam carried out by the shaping system avoids any disruption in the optical coupler.
• the introduction of an optical coupler including a photonic crystal fiber between the shaping system and the scanning optical scanner would induce a filtering of the modulated laser beam (coming from the shaping system) tending to degrade its shaping, and to decrease its power.
• the fiber may be a hollow core photonic crystal fiber, said fiber including a hollow core, and at least one sheath surrounding the hollow core;
• the optical coupler may furthermore comprise:
• each connecting cell may be sealingly mounted at a respective end of the photonic crystal fiber
• each link cell may comprise:
• the apparatus may further comprise at least one vacuum pump, each connecting cell comprising at least one connection terminal opening outwardly of the envelope and being intended to be connected to the vacuum pump;
• the control unit may comprise means adapted to control the activation of the vacuum pump to suck gas contained in the hollow core of the optical fiber photonic crystal.
• Figure 1 is a schematic representation of a mounting including the cutting apparatus according to the invention
• Figure 2 illustrates an intensity distribution of a LASER beam in its focal plane
• FIG. 3 illustrates an exemplary optical coupler of the cutting apparatus illustrated in FIG. 1;
• Figure 4 illustrates a path of movement of a cutting pattern
• Figure 5 illustrates cutting planes of a volume of tissue to be destroyed
• Figure 6 illustrates a therapy apparatus including an articulated arm.
• the invention relates to an apparatus for cutting human or animal tissue by means of a femtosecond laser.
• the invention will be described, by way of example, for cutting a cornea of a human or animal eye.
• the cutting apparatus may be arranged upstream of a target to be treated 7.
• the target 7 is for example a human or animal tissue to be cut such as a cornea or a lens.
• the cutting apparatus comprises:
• a shaping system 2 positioned downstream of the femtosecond laser 1; an optical coupler 3 between the femtosecond laser 1 and the shaping system 2;
• control unit 6 for controlling the femtosecond laser 1, the shaping system 2, the scanning optical scanner 4 and the focusing optical system 5.
• the femtosecond laser 1 is able to emit an initial LASER beam in the form of pulses.
• the laser 1 emits a light of 1030 nm wavelength, in the form of pulses of 400 femtoseconds.
• the laser 1 has a power of between 2 and 20W and preferably of the order of 8W and a frequency of between 100 and 500 kHz.
• the optical coupler 3 makes it possible to transmit the LASER beam 11 coming from the femtosecond laser 1 to the shaping system 2.
• the shaping system 2 extends over the trajectory of the initial LASER beam 11 coming from the femtosecond laser 1. It makes it possible to transform the initial LASER beam 11 into a modulated LASER beam 21. More precisely, the shaping system 2 allows to modulate the phase of the LASER beam 11 to distribute the energy of the LASER beam at a plurality of impact points in its focal plane, this plurality of impact points defining a pattern 8.
• the scanning optical scanner 4 makes it possible to orient the modulated LASER beam 21 to move the pattern 8 along a predefined movement path by the user in a plane of focus 71.
• the optical focusing system 5 makes it possible to move the plane of focus 71 corresponding to the cutting plane of the deviated LASER beam 41 coming from the scanning optical scanner 4.
• the optical coupler 3 makes it possible to propagate the LASER beam 11 between the femtosecond laser and the shaping system 2,
• the shaping system 2 makes it possible to simultaneously generate several impact points 81 defining a pattern 8,
• the scanning optical scanner 4 makes it possible to move this pattern 8 in the plane of focus 71, and
• the optical focusing system 5 makes it possible to move the plane of focus 71 in depth so as to generate cuts in successive planes defining a volume.
• the spatial shaping system 2 makes it possible to vary the wavefront of the initial LASER beam 11 to obtain points of impact 8 separated from each other in the plane of focus 71.
• the shaping system 2 modulates the phase of the initial LASER beam 1 1 from the femtosecond laser 1 to form intensity peaks in the focusing plane 71, each intensity peak producing a point of impact. respective in the focal plane corresponding to the cutting plane.
• the shaping system 2 is, according to the illustrated embodiment, a liquid crystal light spatial modulator, known by the acronym SLM, of the acronym "Spatial Light Modulator".
• SLM makes it possible to modulate the final energy distribution of the LASER beam, in particular in the plane of focus 71 corresponding to the plane of cutting of the fabric 7. More specifically, the SLM is adapted to modify the spatial profile of the wavefront of the beam Primary laser 11 from the femtosecond laser 1 for distributing the energy of the laser beam into different focusing spots in the plane of focus 71.
• Phase modulation of the wavefront can be seen as a two-dimensional interference phenomenon.
• Each portion of the initial LASER beam 11 coming from the source 1 is delayed or advanced with respect to the initial wavefront so that each of these portions is redirected so as to achieve a constructive interference at N distinct points in the focal plane of a lens.
• This redistribution of energy at a plurality of impact points 81 occurs only in one plane (i.e., the focus plane 71) and not throughout the path of propagation of the modulated LASER beam.
• the observation of the modulated LASER beam before or after the focusing plane does not make it possible to identify a redistribution of energy at a plurality of different impact points 81, because of this phenomenon which can be assimilated to constructive interferences (which occur only in one plane and not throughout the propagation as in the case of the separation of an initial LASER beam into a plurality of secondary LASER beams).
• FIG. 2 schematically illustrates intensity profiles 72a-72e obtained for three examples of distinct optical assemblies.
• an initial LASER beam 11 emitted by a laser source 1 produces a gaussian intensity peak 72a at an impact point 73a in a focusing plane 71.
• the insertion of a separation splitter beam 9 between the source 1 and the plane of focus 71 induces the generation of a plurality of secondary LASER beams 91, each secondary LASER beam 91 producing a respective point of impact 73b, 73c in the focusing plane 71 of the secondary LASER beams 91.
• the insertion between the source 1 and the focusing plane 71 of an SLM 2 programmed using a phase mask forming a modulation setpoint induces the modulation of the phase of the wavefront of the beam.
• Initial LASER 11 from the source 1.
• the LASER beam 21, the phase of the wavefront of which has been modulated makes it possible to induce the production of several peaks of intensity 73d, 73e separated spatially in the plane of focus 71, each peak 72d, 72nd correspondent at an impact point 73d, 73e respectively making a cut.
• the modulation technique of the forehead phase waveform makes it possible to generate in the target tissue several simultaneous gas bubbles without reduction of the initial LASER beam 1 1 produced by the femtosecond laser 1.
• the SLM is a device consisting of a controlled-orientation liquid crystal layer for dynamically shaping the wavefront, and thus the phase of the LASER beam.
• the liquid crystal layer of an SLM is organized as a grid (or matrix) of pixels.
• the optical thickness of each pixel is electrically controlled by orientation of the liquid crystal molecules belonging to the surface corresponding to the pixel.
• the SLM exploits the principle of anisotropy of liquid crystals, that is to say the modification of the index of liquid crystals, according to their spatial orientation.
• the orientation of the liquid crystals can be carried out using an electric field.
• the modification of the liquid crystal index modifies the wavefront of the LASER beam.
• the SLM implements a phase mask, that is to say a map determining how the phase of the beam must be modified to obtain a given amplitude distribution in its plane of focus 71.
• the phase mask is a two-dimensional image with each point associated with a respective pixel of the SLM.
• This phase mask makes it possible to control the index of each liquid crystal of the SLM by converting the value associated with each point of the mask - represented in grayscale between 0 and 255 (hence from black to white) - into a control value - represented in a phase between 0 and 2 TT.
• the phase mask is a modulation set displayed on the SLM to reflect in reflection an unequal spatial phase shift of the LASER beam illuminating the SLM.
• the gray level range may vary depending on the SLM model used.
• the gray level range may be between 0 and 220.
• the phase mask is generally calculated by an iterative algorithm based on the Fourier transform, or on various optimization algorithms, such as algorithms genetic, or simulated annealing. Different phase masks can be applied to the SLMs depending on the number and position of the desired impact points in the focal plane of the LASER beam. In all cases, one skilled in the art can calculate a value at each point of the phase mask to distribute the energy of the LASER beam into different focusing spots in the focal plane.
• the SLM thus allows, starting from a Gaussian LASER beam generating a single point of impact, and by means of the phase mask, to distribute its energy by phase modulation so as to simultaneously generate a plurality of impact points in its focus plane from a single phase-modulated LASER beam (a single beam upstream and downstream of the SLM).
• the LASER beam phase modulation technique allows other improvements, such as better surface quality after cutting or a reduction in endothelial mortality.
• the different points of impact of the pattern may, for example, be evenly spaced on the two dimensions of the focal plane of the LASER beam, so as to form a grid of LASER spots.
• the shaping system 2 makes it possible to perform a surgical cutting operation in a fast and efficient manner.
• the SLM makes it possible to shape dynamically the wavefront of the LASER beam since it is numerically configurable. This modulation allows the shaping of the LASER beam in a dynamic and reconfigurable way.
• the SLM can be configured to format the LASER beam wavefront in any other way.
• each impact point may have any geometrical shape, other than circular (for example in an ellipse, etc.). This may have certain advantages depending on the application considered, such as an increase in the speed and / or the quality of the cut.
• the optical coupler 3 allows the transmission of the LASER beam 1 1 between the femtosecond laser 1 and the shaping system 2.
• the optical coupler 3 advantageously comprises an optical fiber 31.
• the optical fiber 31 may be a photonic crystal fiber.
• a photonic crystal fiber, or "PCF" Photonic-Crystal Fiber
• PCF Photonic-Crystal Fiber
• These fibers ensure the confinement of electromagnetic waves in the heart of the fiber.
• These photonic crystal fibers offer a wide variety of possibilities for guidance by adjusting their optogeometric parameters such as, for example, the diameter of the inclusions, the distribution of the inclusions, the periodicity (not between two inclusions), the number of layers, the index of used materials.
• the optical fiber 31 is a hollow core photonic crystal fiber.
• a hollow-core photonic crystal fiber is an optical fiber that guides the light essentially within a hollow region (the core of the fiber), so that only a minor portion of the optical power propagates in the material solid fiber (typically silica). According to the standard physical mechanism for guiding light into a fiber, this should not be possible: normally, the refractive index of the fiber core must be higher than that of the surrounding cladding material, and there is no means of obtaining a refractive index of glass below that of air or vacuum, at least in the optical region.
• a different guiding mechanism can be used, based on a photonic bandgap, as can be done in a photonic crystal fiber. Such fibers are also called photonic bandgap fibers.
• the attractions of hollow-core photonic crystal fibers are primarily that the primary guidance in the hollow region minimizes the non-linear effects of the LASER beam 1 1 and allows a high damage threshold.
• the document FR 3 006 774 describes a waveguide in the form of a hollow core photonic crystal fiber comprising a sheath, the absence of a central part of the capillary forming the hollow core.
• the use of a hollow-core photonic crystal fiber makes it possible to filter the LASER beam 1 1 from the femtosecond laser 1 in order to facilitate its shaping by the shaping system 2. More precisely, the use of a hollow-core photonic crystal fiber makes it possible to limit the divergence of the LASER beam 1 1 (ie spread profile) by improving its directivity (which makes the LASER beam 1 1 cleaner by limiting the spreading of its profile).
• a hollow-core photonic crystal fiber makes it possible to confine the light more efficiently than a conventional solid-core fiber.
• the hollow-core photonic crystal fiber comprises: a hollow core 311,
• the hollow region 311 of the hollow-core photonic crystal fiber can be evacuated to limit the propagation losses of the LASER beam 11 from the femtosecond laser 1.
• a gas can be injected into the hollow region to exploit the high optical intensity in the fiber - for example for a high harmonic generation of the LASER beam 11 from the femtosecond laser 1.
• the optical coupler 3 comprises first and second connecting cells 32, 33 mounted in a sealed manner at each end of the hollow-core photonic crystal fiber.
• Each link cell 32, 33 comprises:
• a transmission channel 322, 332 housed in the envelope 321, 331, the transmission channel 322, 332 permitting the passage of the LASER beam 11 inside the envelope 321, 331,
• a window 323, 333 transparent to the LASER radiation at one end of the transmission channel 322, 332 for the entry (or exit) of the LASER beam
• connection terminal 324, 334 opening towards the outside of the envelope
• the activation of the vacuum pump P makes it possible to put the hollow core 311 of the optical fiber 31 under vacuum by pumping at the level of the link cells 32, 33 located at the two ends of the optical fiber 31.
• the fact of carrying out a vacuum pumping at each end of the optical fiber 31 facilitates evacuation of the hollow core over the entire length of the optical fiber 31.
• Optical scan scanner The scanning optical scanner 4 makes it possible to deflect the phase modulated LASER beam 21 so as to move the pattern 8 at a plurality of positions 43a-43c in the plane of focus 71 corresponding to the cutting plane.
• the scanning optical scanner 4 comprises:
• an input port connected to the optical coupler 3 for receiving the phase-modulated LASER beam 21 coming from the shaping unit 2,
• the optical scanner 4 used is for example an IntelliScan III scanning head from SCANLAB AG.
• the inlet and outlet ports of such an optical scanner 4 have a diameter of the order of 10 to 20 millimeters, and the attainable scanning speeds are of the order of 1 m / s to 10 m / s following the focal length of the optics used.
• the mirror (s) is (are) connected (s) to (or) motor (s) to allow their pivoting.
• This motor (s) for pivoting the mirror (s) is (are) advantageously controlled by the unit of the control unit 6 which will be described in more detail below.
• the control unit 6 is programmed to control the scanning optical scanner 4 so as to move the pattern 8 along a path of movement 42 contained in the plane of focus 71.
• the travel path 42 includes a plurality of cut segments 42a-42c.
• the displacement path 42 may advantageously have a crenellated or spiral shape, etc.
• the scanning of the beam is of great importance for the result of the cut obtained. Indeed, the scanning speed used, as well as the scanning pitch, are parameters influencing the quality of the cut.
• an optical coupler including an optical fiber 31 of hollow-body crystal type allows, when using a setting in multipoint form 81, to improve the homogeneity of the energy distribution between the points in the extreme case of very close points of impact (center-to-center spacing between two shaped points smaller than the diameter of a point) .
• the cutting apparatus further comprises a Dove prism. It is advantageously positioned between the optical color 3 and the scanning optical scanner 4. The prism of Dove makes it possible to implement a rotation of the pattern 8 which may be useful in certain applications or to limit the size of the area of priming each cutting segment 42a-42c.
• control unit 6 can be programmed to activate the femtosecond laser 1 when the scanning speed of the optical scanner 4 is greater than a threshold value. This makes it possible to synchronize the emission of the LASER beam 1 1 with the scan of the scanning optical scanner 4. More precisely, the control unit 6 activates the femtosecond laser 1 when the pivoting speed of the mirror (s) optical scanner 4 is constant. This makes it possible to improve the quality of cutting by performing a homogeneous surfacing of the cutting plane.
• the optical focusing system 5 makes it possible to move the plane of focus 71 of the modulated and deflected LASER beam 41 in a plane for cutting the tissue 7 desired by the user.
• the optical focusing system 5 comprises:
• one (or more) motorized lens (s) to allow its (their) displacement in translation along the optical path of the LASER beam modulated in phase and deviated
• an outlet orifice for sending the focused LASER beam towards the tissue to be treated.
• the lens (or lenses) used with the optical focusing system 5 may be flat-field lenses.
• Flat-field lenses provide a focus plane over the entire XY field, unlike standard lenses for which it is concave. This ensures a constant focused beam size across the field.
• the control unit 6 is programmed to control the displacement of the lens (s) of the focusing optical system 5 along an optical path of the LASER beam so as to move the focusing plane 71 to at least three respective cutting planes 72a-72e so as to form a stack of cutting planes 7. This allows to cut in a volume 74, for example in the context of refractive surgery.
• the control unit 6 is able to control the displacement of the optical focusing system 5 to move the plane of focus 71 between a first end position 72a and a second end position 72e, in that order.
• the second extreme position 72e is closer to the femtosecond laser 1 than the first extreme position 72a.
• the cutting planes 72a-72e are formed starting with the deepest cutting plane 72a in the fabric and stacking the successive cutting planes to the most superficial cutting plane 72e in the fabric 7. It avoids and the problems associated with the penetration of the LASER beam into the fabric 7. Indeed, the gas bubbles form an opaque bubble barrier (known under the name of "OBL", acronym of the English expression “Opaque Bubble Layer”) preventing the propagation of energy from the LASER beam beneath them. It is therefore preferable to start generating the deepest gas bubbles first to improve the efficiency of the cutting apparatus.
• OBL opaque bubble barrier
• an optical coupler including an optical fiber 31 of the hollow-core photonic crystal type (rather than an optical assembly composed of mirrors for guiding the LASER beam 11) makes it possible to filter the LASER signal 11 coming from the femtosecond laser by removing its possible aberrations. It is thus possible to reduce the distance between two successive cutting planes (distance between successive cutting planes less than the diameter of a point of impact) to achieve a high precision cut in a volume 74.
• control unit 6 makes it possible to control the various elements constituting the cutting apparatus, namely the femtosecond laser 1, the shaping system 2, the scanning optical scanner 4 and the optical focusing system 5.
• the control unit 6 is connected to these different elements by means of one (or more) communication buses allowing:
• control signals such as
• the control unit 6 may be composed of one (or more) work station (s), and / or one (or more) computer (s) or may be of any other type known to the person in charge. job.
• the control unit 6 may for example comprise a mobile phone, an electronic tablet (such as an IPAD®), a personal assistant (or "PDA", acronym of the expression “Personal Digital Assistant”), etc.
• the control unit 6 comprises a processor programmed to enable control of the femtosecond laser 1, the shaping system 2, the scanning optical scanner 4, the focusing optical system 5, and so on.
• an optical coupler (3) including a photonic crystal optical fiber (31) the cutting apparatus described above can be mounted in a therapy apparatus including an articulated arm 200 as illustrated in FIG. figure 6.
• the arm 200 comprises several arm segments 201 -204 connected by joints 205-207 (pivot links or ball joint) motorized to allow the automatic rotational movement of the different segments 201 -204 relative to each other.
• the arm is articulated to allow movement of the free end of the arm along three orthogonal axes X, Y and Z:
• the free end of the arm 2 may comprise an immobilizing member equipped with a suction ring capable of sucking an ocular tissue to be treated and holding it firmly in position.
• the arm 2 is for example a TX260L sold by the company STAUBLI.
• the shaping system 2, the scanning optical scanner 4 and the optical focusing system 5 can be mounted in the end segment 204 of the arm 200, while the femtosecond laser 1 can be integrated into a mobile box.
• the optical coupler 3 extending between the box 210 and the end segment 204 to propagate the LASER beam 1 1 from the femtosecond laser 1 to the shaping system 2.
• the invention makes it possible to have an effective and precise cutting tool.
• the reconfigurable modulation of the wavefront of the LASER beam makes it possible to generate multiple simultaneous impact points 81 each having a size and a controlled position in the plane of focus 71. These different impact points 81 form a pattern 8 in the focal plane 71 of the modulated LASER beam.
• an optical coupler 3 including a hollow-core photonic crystal fiber 31 1 makes it possible to reduce the distance between the different impact points forming the pattern. Indeed, by limiting the phenomenon of spreading of the light spectrum, the optical coupler including a hollow-core photonic crystal fiber makes it possible to make the phase-modulated LASER beam cleaner.

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• 2018
  • 2018-01-25 FR FR1850577A patent/FR3076995B1/fr active Active
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